Volunteer Facilitator Application

Contact Details

First Name

Last Name

Email Type

Mobile Phone

Opt-In for Text Communication

Yes

Street Address

City

State

Zip Code

Are you or have you been a Willow House Family Member? (i.e. have you attended / signed up for group support services?)

YesNo

Employment

Current Employer

Current Title

Current Job Description

Please list your previous volunteer experience

Organization (1)

Type of Volunteer Work (1)

Organization (2)

Type of Volunteer Work (2)

Organization (3)

Type of Volunteer Work (3)

Organization (4)

Type of Volunteer Work (4)

Volunteer with Willow House

How did you hear about Willow House?

How did you hear about volunteer opportunities with Willow House

Why are you interested in volunteering with grieving children & teens at Willow House?

Please describe your personal and professional experiences working with children and/or teens. Please specify age and duration.

Which traits and skills do you have that you feel will be most applicable in working with children and teens?

Have you experienced the death of a family member or close friend?

YesNo

How long has it been since the death(s)? Please also describe how the person(s) in your life died and how you coped with the experience(s)

Do you have any experience in the creative arts, fitness, health or alternative therapies? If so, please describe.

Do you have any clinical certifications or degrees? If so, please list each certification and degree with year & location obtained.

Have you ever been convicted of any felonies or misdemeanors other than for minor traffic offenses?

YesNo

If yes, please explain

What is your current availability?

Please list and special skills/talents you have that may be helpful to Willow House.

Any additional comments, concerns, or questions.

Resume/CV Upload

Signature

Willow House requires that background checks be completed for all volunteers who are working directly with Willow House children and teens in the program setting. Your signature below indicates your understanding of this volunteer policy and your agreement to your name being submitted for a background check following your completion of the training.

Signature (Type Full Name)

Date

Hidden Fields

Volunteer Contact Record Type Id

WH Family Member Contact Record Type Id

Vol Facilitator Case Record Type Id

General Volunteer Case Record Type Id

Contact Information